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CITY OF._.EDMONDS
C& MU" N'ITY SERVICES DEPARTMENT
RIGHT-OF-WAY CONSTRUCTION PERMIT
RECEIVED Permit No. 1) 1 - \ \ -I
A. * Owner: Washington Natural Gas Comp ny
�IT'Mercer Street
V&Wio ddress WA 98111
City State
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At'kl 7 IM Issue Date 4 — 1 6 - 5 \
ENq%WNp actor:
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CA vs Ici I
Name
Mailing Address
City State Zip
State License Number Telephone Number
C. 9 Address or Vicinity of Construction: 22819 78 Avenue West
Type of Work to be Done: Install New Service
D. 0 Work in Connection With: El Sub or Plat 0 Single Family El City Projects
0 Commercial 0 Multifamily Kx Utility
E. 0 Pavement Cut: El Y F-1 N F. 0 Size of Cut: 2 X 4 (1) @ Gas
APPLICANT TO READ AND SIGN
INDEMNITY: Applicant understands and by his signature to this application, agrees to hold the City of Edmonds
harmless from any injuries, damages, or clai s of an kind or description whatsoever, forseen or unforseen, that may
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be made against the City of Edmonds, or any of it'�o rtments or employees, including or not limited to the defense
of any legal proceedings including defense costs, co sts, �pj at orey, feT by reason of granting this permit.
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YEAR FOLLOWING THE FINAL INSPECTION AND ACCEPTANCE OF THE WORK.
Estimated restoration fees will be held until the final street patch is completed by City forces, at which time a debit or credit will be
processed for issuance to the applicant.
• A 24 hour notice is required for inspection; Please call Engineering: 771-3202
• Work is to be inspected during progress and at completion.
• Restoration to be in accordance with City Code.
• Street to be kept clean at all times.
• Traffic Control to be in accordance with City regulations.
• All street -cut ditches must be patched with asphalt or City approved material prior to end of working day;
NO EXCEPTIONS.
I understand the above and that this permit must be available at the job site for inspection purposes at all times.
Signature:
= 7 in
Owner or Contractor
Date: April 10, 1991
This Permit Must be Posted at the Job Site For Inspection Purposes
Call DIAL -A -DIG Prior to Beginning Work
APPROVED BY: Ac)y V�j
Time Authorized: Void after 'L Z- days.
Special Conditions: to,-
PERMIT FEE: 'AO - (c)0 kn-_ L& L!"
Restoration Fee:
Receipt No.: -
Fund 111 Fee:
Street Cut Dimensions: - x - = $
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RELEASED BY: Date-4 - INSPECTED BY Date
NO WORK TO BEGIN PRIOR TO PERMIT ISSUANCE
Eng. Div. March 1989
Eng. Div. July 1985
Addendum to:
City of Edmonds
Permit Application
Engineering Aide : Kerry Walsh
Washington Natural Gas
622-6767 x 2588
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NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be lia-ble for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).